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Books, Papers, and Publications


At PelvicSanity, we are dedicated to adding to the scientific research in pelvic health, helping both patients and the medical community better understand and treat these complex conditions.

The Interstitial Cystitis Solution


FairWinds Press, 2016

Written by leading IC expert Dr. Nicole Cozean, The Interstitial Cystitis Solution is the best-selling and award-winning comprehensive guide to healing with IC.  While the process is a journey, thousands of people with interstitial cystitis live healthy, happy lives - and so can you!

Called 'The Best Book on IC in 20 Years', the book is filled with practical, positive information about the complex condition, The Interstitial Cystitis Solution is a guidebook on the healing journey. With full reviews of the most recent research, the book focuses on helping patients create their own holistic treatment plan to deliver the best results.  Learn about alternatives to surgery and medication, understand the role of the pelvic floor in treating IC, and discover stretches and self-care techniques that can relieve symptoms. The IC Solution also contains other patient resources like a symptom log to track progress, a bladder diary, a guide to treating IC on a budget, and a flare management program.  

The IC Solution reached #1 bestselling status on Amazon and has been featured in publications including Reader's Digest, US News & World Report, and the ICA Update.


e-Book, 2018

This e-book by the PelvicSanity staff provides an overview of endometriosis: the diagnosis, symptoms, and treatment options available.  ​

Many patients are surprised to learn that the severity of symptoms is not correlated with the severity or location of the endometriosis.  There are many treatment options available, and a multi-disciplinary approach yields the best results for patients.  

Click here to download the full e'book "Hello Endo: An Intro to Endometriosis"

e-Book, 2018

Gut health plays an integral role in the overall well-being of the entire body and pelvic floor.  This PelvicSanity e-book gives a top-level view of gut health, including what is and isn't normal and how anyone can improve the function of their digestive system.

Bowel dysfunction can take many forms, but common symptoms include constipation, bloating, abdominal cramping, flatulence, nausea, or heartburn.  We've found 73% of patients with pelvic floor dysfunction also present with related bowel dysfunction. 

Click here to download the full e'book "Gut Health: The Complete Patient Guide"


ICA Update, Summer 2017

Exercise has many benefits - improving cardiovascular health, increasing restful sleep, boosting mood, energy and the immune system - but it can be challenging with interstitial cystitis.

It can be an important part of healing with IC, but appropriate exercise differs for patients.  As with all aspects of IC, listening to your body is extremely important when returning to exercise.

Regardless of where you are in your IC journey, adding exercise can be an important step.  It can be scary for some, but always listen to your body, start slow, and consult with a qualified pelvic floor physical therapist if you need help!

Click here to download the full article "Take the First Step!" here


ICA Update, Winter 2017

We often discuss how to treat pelvic floor dysfunction (PFD), but many patients and their doctors don't have a tool for recognizing PFD.  More than 85% of patients with interstitial cystitis, for example, have pelvic floor dysfunction but often aren't referred to physical therapy or given an at-home regimen that can help reduce symptoms.

In studying the common complaints of our patients, we created a 10-question survey that correctly identifies 91% of patients with pelvic floor dysfunction.  In this article, we explore how to recognize and then resolve pelvic floor dysfunction.

Common indicators of pelvic dysfunction include pelvic pain, urinary symptoms, constipation, pain with intercourse, or increased symptoms with prolonged sitting.

Click here to download the full article "Recognizing and Resolving Pelvic Floor Dysfunction." 


International Pelvic Pain Society, 2017

At PelvicSanity, we monitored thirteen consecutive patients with interstitial cystitis to track their progress.  Upon initial evaluation, patients were in extreme pain - on average, 7.6 out of 10.  More than half of patients had seen 5 or more doctors for their symptoms without relief.  

All thirteen (100%) of patients noted an improvement with pelvic floor physical therapy.  More than half reported an improvement within the first three visits, after having struggled with the condition for years.  Results were published by the 2017 meeting of the International Pelvic Pain Society.  Patients also reported experiencing:

  • 65% Reduction in Pain

  • 67% Reduction in Bother of Symptoms

  • 61% Reduction in 

Click here to download the full abstract, "Benefits of Pelvic Floor Physical Therapy for Patients Diagnosed with Interstitial Cystitis (IC/BPS)"


International Pelvic Pain Society, 2017

At PelvicSanity, we've noticed that most of our patients have to find pelvic floor physical therapy themselves - in fact, less than 10% of our patients feel they were referred from their doctor at the proper time.  Almost half find pelvic physical therapy on their own, while about 40% either have to specifically ask their doctor about it or feel they should have been referred significantly earlier.

In this research, we sought to develop an easy-to-administer questionnaire that could accurately detect pelvic floor dysfunction to help doctors and other physical therapists know when the pelvic floor is involved.  In analyzing all of our patient population, we created a 10-question protocol that correctly identified more than 90% of patients with pelvic floor dysfunction based solely on their history and symptoms.  

If a patient answers 'yes' to 3 or more of the questions, pelvic floor dysfunction is likely.  Among PelvicSanity, the average score was 5.2 - right where it would be expected with a normal distribution.  

We hope this helps practitioners identify patients with pelvic floor dysfunction earlier in their medical journey, allowing them to get help sooner.

Click here to download the full article, "Creating a Screening Questionnaire to Identify Patients with Muscoloskeletal Components to Pelvic Pain and Symptoms."

Click here to download the Cozean Pelvic Floor Screening Protocol


ICA Update, Summer 2017

Hope can be an invaluable tool on the road to recovery from interstitial cystitis or other chronic pain conditions.  This article, based on the quote from actor Michael J. Fox, discusses how both knowledge and an optimistic attitude are necessary components of hope.

Optimism without knowledge is wishful thinking, which makes it easy to be disappointed when there are setbacks.  Knowledge without optimism is discouragement; you may know all the right answers, but despair saps the energy you need to pursue healing.  Uninformed pessimism is catastrophizing, and both knowledge and optimism need to be cultivated in order to regain hope.

This article should help you identify what category you're currently in, and ways to work yourself back to a place of hope for recovery.

"Hope is not something we have or we don't.  Hope is something that can be cultivated, or it can or lost."

Click here to download the full article, "Hope is Informed Optimism"


ICA Update, Summer 2017

Many patients with interstitial cystitis or other chronic conditions can struggle to build a positive, trusting relationship with their doctor. Appointments are generally shorter, and many patients go to multiple doctors before being correctly diagnosed (or never receive a formal diagnosis).

In this article, we discuss how to bring the right paperwork to your appointment, how to set realistic expectations for what your doctor can - and can't - do for an IC patient, how to set clear goals for each appointment, and how to speak your doctor's language.

Your relationship with your doctor should feel like a partnership, with trust and respect on both sides.  Cultivating that relationship can be one of the most important things for a patient with a chronic condition like IC.  

Click here to download the full article, "Building a Solid Doctor-Patient Relationship


Journal of Women's Health Physical Therapy, 2017

This case report from Dr. Nicole Cozean details the physical therapy treatment of a complex patient with interstitial cystitis. This report can be a guide for both physical therapists who work with complex patients as well as for patients themselves.

The IC patient in this case report came into physical therapy in severe pain. She had been forced to take a leave of absence from her job. As is common with IC patients, she also reported low back pain and pain with intercourse.

The patient was treated for 19 visits over the course of three months. Pain was decreased by nearly 80% with physical therapy, and the patient reported major improvements in quality of life.  She was able to return to full-time employment and resume sexual intercourse with her partner, which the pain of the condition had made impossible.

Click here to download the full Case Report


Interstitial Cystitis Association, IC Update, 2016

Stretching can be a powerful tool for patients with IC or pelvic floor dysfunction. This article details some of the stretches in the PelvicSanity IC Stretching Regimen for patients. These exercises can help relax the pelvic floor, return muscles to their proper length, and maintain the gains of physical therapy.

The full stretching regimen is detailed in The Interstitial Cystitis Solution, but these are some of the most important ones for patients to concentrate on. Spending just twenty minutes a day with these stretches can make dramatic improvements, and can also be part of your personal Flare-Busting Plan.

Click here to download the full article


Interstitial Cystitis Association, IC Update, 2016

This article, featured in the IC Update, gives a brief overview of physical therapy for interstitial cystitis.  The pelvic floor is the setting for IC, as these muscles support the bladder and control urination.

Interstitial cystitis puts a great deal of strain on the pelvic floor. When these muscles are tight and knotted, they can actually be causing the symptoms that patients generally assume are coming from the bladder. 


Pelvic floor physical therapy works to eliminate the part of the condition that is being caused by the pelvic floor muscles. For some patients, this is the major source of their symptoms; for others, it is only exacerbating problems caused by the bladder.  Either way, the pelvic floor needs to be addressed in order for true healing to take place.

Pelvic floor physical therapy is the most proven treatment for interstitial cystitis - it's the only treatment given an 'A' evidence grade by the American Urological Association and is recommended in the first line of medical treatment.  It's also the only treatment that has been proven to sustainable help the majority of patients.

Click here to download the full article


Interstitial Cystitis Association, IC Update, 2016

It's not just women who benefit from pelvic floor physical therapy; pelvic PT is just as effective for men.  In studies of men with interstitial cystitis or chronic prostatitis, they respond just as favorably to physical therapy as women.  Men showed a decrease in pain and urinary symptoms with physical therapy.

Male pelvic pain and dysfunction - whether it's diagnosed as interstitial cystitis, chronic prostatitis, pudendal neuralgia, or urinary symptoms - can be successfully treated with pelvic floor physical therapy from a trained pelvic specialist.

Click here to download the full article

Pelvic floor physical therapy is the most proven treatment for interstitial cystitis. It’s the only therapy given an evidence grade of ‘A’ by the American Urological Association and recommended in the first line of medical treatment. But patients often wonder how does treating muscles and fascia reduce urinary symptoms and pain that seem to be coming from the bladder?

Physical therapy is the most proven treatment for interstitial cystitis.  In studies conducted at PelvicSanity, we evaluated our patients with IC and found that they saw more than a 60% improvement in both the pain and bother of their symptoms.  More than half saw benefits within the first three visits.

In April of 2018, Nicole will be teaching the first continuing education course for physical therapists focused on interstitial cystitis.

"Most importantly, quercetin is one of the few supplements that have been proven effective in clinical trials for pelvic pain.  In a randomized study of men with chronic prostatitis, quercetin was shown to benefit more than 2 in 3 men.  Symptoms were improved by an average of 38 percent, without significant side effects being reported by the researchers."

Quercetin is part of our Pelvic Health Supplement pack, along with L-Arginine and Omega-3 Fish Oil.

"By resolving the trigger points in these muscles, pelvic floor physical therapy works to address the underlying cause of pelvic pain and urinary symptoms. This typically involves both external and internal trigger point release techniques, clearing inflammation from the fascia, and a customized at-home program.

"The results were striking.  In just ten visits, 64% of men reported their symptoms were either moderately or markedly improve, and more than 80% reported at least some benefit...."

The goal is to improve the current trial-and-error approach to treatment. If we can identify underlying phentoypes, it may be possible to predict which treatments will be most effective for a specific patient. This fits with a more individualized approach to medicine, as we realize that there’s no one-size-fits-all approach for complex conditions.

"Many patients with chronic prostatitis and pelvic pain report that their symptoms get worse during the cold weather months.  It’s not just in your head – recent research confirmed the relationship between weather and pain....In fact, pain intensity was reported to be three times greater during the winter months, and the correlation was present for every man in the study.

These results correspond with the muscles of the pelvic floor being a driving force behind pelvic pain with chronic prostatitis.  As the temperature drops, these muscles get even tighter, irritating the nerves that run through the pelvis...."

"The number of trigger points was significantly associated with anxiety, stress, pain experience, and both physical and mental quality of life in patients....Multiple treatments are effective in reducing or eliminating trigger and tender points for pelvic pain. Pelvic floor physical therapy for chronic prostatitis resolves trigger points with manual therapy..."

"“We treat many men for pelvic pain and/or urinary symptoms, often diagnosed as chronic prostatitis, ‘cyclist syndrome,’ or levator ani syndrome. It’s common for these men to also be suffering from sexual pain or dysfunction that they may not even realize is related, until it also starts to improve with pelvic floor physical therapy.” — Dr. Nicole Cozean, PT, DPT, WCS, CSCS

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